The abuse that occurs in fabricated or induced illness (FII) takes a range of forms and can be difficult to recognise, but there are warning signs to look out for.

Warning signs

A clinician may suspect fabricated or induced illness if, after carrying out examinations and tests, there appears to be no explanation for the child's symptoms (for more information, you can read the NICE guidance about when to suspect child maltreatment in under 18s).

They should also look out for one or more of the following warning signs:

symptoms only appear when the parent or carer is present

the only person claiming to notice symptoms is the parent or carer

the affected child has an inexplicably poor response to medication or other treatment

if one particular health problem is resolved, the parent or carer may then begin reporting a new set of symptoms

the child's alleged symptoms don't seem plausible – for example, a child who has supposedly lost a lot of blood but doesn't become unwell

the parent or carer has a history of frequently changing GPs or visiting different hospitals for treatment, particularly if their views about the child's treatment are challenged by medical staff

the child's daily activities are being limited far beyond what you would usually expect as a result of having a certain condition – for example, they never go to school or have to wear leg braces even though they can walk properly

the parent or carer has good medical knowledge or a medical background

the parent or carer doesn't seem too worried about the child's health, despite being very attentive

the parent or carer develops close and friendly relationships with healthcare staff, but may become abusive or argumentative if their own views about what's wrong with the child are challenged

one parent (commonly the father) has little or no involvement in the care of the child

the parent or carer encourages medical staff to perform often painful tests and procedures on the child (tests that most parents would only agree to if they were persuaded that it was absolutely necessary)

Patterns and levels of abuse

The patterns of abuse found in cases of FII usually fall into one of six categories. These are ranked as follows, from least severe to most severe:

exaggerating or fabricating symptoms and manipulating test results to suggest the presence of an illness

intentionally withholding nutrients from the child or interfering with nutritional intake

inducing symptoms by means other than poisoning or smothering, such as using chemicals to irritate their skin

poisoning the child with a substance of low toxicity – for example, using laxatives to induce diarrhoea

poisoning the child with a poison of high toxicity – for example, using insulin to lower a child's blood sugar level

deliberately smothering the child to induce unconsciousness

Previous case reports of FII have uncovered evidence of:

parents or carers lying about their child's symptoms

parents or carers deliberately contaminating or manipulating clinical tests to fake evidence of illness – for example, by adding blood or glucose to urine samples, placing their blood on the child's clothing to suggest unusual bleeding, or heating thermometers to suggest the presence of a fever

poisoning their child with unsuitable and non-prescribed medicine

infecting their child's wounds or injecting the child with dirt or faeces (stools)

inducing unconsciousness by suffocating their child

not treating or mistreating genuine conditions so they get worse

withholding food, resulting in the child failing to develop physically and mentally at the expected rate